Does the Effect of a 3-Year Lifestyle Intervention on Body Weight and Cardiometabolic Health Differ by Prediabetes Metabolic Phenotype? A Post Hoc Analysis of the PREVIEW Study

Abstract

OBJECTIVE To examine whether the effect of a 3-year lifestyle intervention on body weight and cardiometabolic risk factors differs by prediabetes metabolic phenotype. RESEARCH DESIGN AND METHODS This post hoc analysis of the multicenter, randomized trial, PREVention of diabetes through lifestyle interventions and population studies In Europe and around the World (PREVIEW), included 1,510 participants with prediabetes (BMI ≥25 kg ⋅ m−2; defined using oral glucose tolerance tests). Of these, 58% had isolated impaired fasting glucose (iIFG), 6% had isolated impaired glucose tolerance (iIGT), and 36% had IFG+IGT; 73% had normal hemoglobin A1c (HbA1c; <39 mmol ⋅ mol−1) and 25% had intermediate HbA1c (39–47 mmol ⋅ mol−1). Participants underwent an 8-week diet-induced rapid weight loss, followed by a 148-week lifestyle-based weight maintenance intervention. Linear mixed models adjusted for intervention arm and other confounders were used. RESULTS In the available-case and complete-case analyses, participants with IFG+IGT had greater sustained weight loss after lifestyle intervention (adjusted mean at 156 weeks −3.5% [95% CI, −4.7%, −2.3%]) than those with iIFG (mean −2.5% [−3.6%, −1.3%]) relative to baseline (P = 0.011). Participants with IFG+IGT and iIFG had similar cardiometabolic benefits from the lifestyle intervention. The differences in cardiometabolic benefits between those with iIGT and IFG+IGT were minor or inconsistent in different analyses. Participants with normal versus intermediate HbA1c had similar weight loss over 3 years and minor differences in cardiometabolic benefits during weight loss, whereas those with normal HbA1c had greater improvements in fasting glucose, 2-h glucose (adjusted between-group difference at 156 weeks −0.54 mmol ⋅ L−1 [95% CI −0.70, −0.39], P < 0.001), and triglycerides (difference −0.07 mmol ⋅ L−1 [−0.11, −0.03], P < 0.001) during the lifestyle intervention. CONCLUSIONS Individuals with iIFG and IFG+IGT had similar improvements in cardiometabolic health from a lifestyle intervention. Those with normal HbA1c had greater improvements than those with intermediate HbA1c.

Metabolic phenotyping in people living with obesity: Implications for dietary prevention

“…Indeed, dietary interventions have a differential effect on body weight, weight maintenance and cardiometabolic risk factors in men compared to women, as extensively reviewed elsewhere [ 23 ]. The recent PREVIEW study investigated age- and sex-specific effects of a low-energy diet (LED), followed by a 3 year lifestyle-based weight maintenance intervention in overweight adults with prediabetes [ 83 ]. A lifestyle intervention had less beneficial effects with respect to body composition and cardiometabolic health markers in older than younger adults, despite better weight maintenance, which might be due to the loss of more fat-free mass in older adults.…”

“…A lifestyle intervention had less beneficial effects with respect to body composition and cardiometabolic health markers in older than younger adults, despite better weight maintenance, which might be due to the loss of more fat-free mass in older adults. The LED, followed by a lifestyle intervention, showed less beneficial effects on body weight and body composition in women than men [ 83 ]. The available evidence suggests that factors such as age and sex should be taken into account to optimize prevention and treatment strategies for those at risk of or already living with cardiometabolic diseases.…”

“…Post-hoc analyses in large intervention studies show responders and non-responders that feed back to tissue metabotype [ 5 – 8 , 83 ]. Parameters associated with glucose metabolism and IR, including plasma glucose and insulin concentrations and derived indices can serve as valuable predictors of the outcome of a dietary intervention [ 5 , 6 , 11 ].…”

Association between heme oxygenase-1 and hyperlipidemia in pre-diabetic patients: a cross-sectional study

“…Patients diagnosed with pre-diabetes are at higher risk of developing T2DM (16), and macrovascular complications may happen well before official diagnosis of diabetes (17). Management of lifestyle, weight, blood sugar, and blood lipids is essential for preventing the incidence of adverse events (18)(19)(20)(21)(22)(23). On the aspect of blood lipids, individuals who are under condition of pre-diabetes tend to have higher prevalence of dyslipidemia than people whose plasma glucose are in the normal range; also, research has shown a positive association between high level of LDL-C and increased probability of pre-diabetes (24, 25).…”

Comment on Rooney et al. Global Prevalence of Prediabetes. Diabetes Care 2023;46:1388–1394

“…However, the efficacy of LCDs has been examined scarcely in individuals with i-IFG, who share the same pathophysiological defects as those in people with type 2 diabetes (2). One of the first pieces of evidence comes from a post hoc analysis of the PREVIEW (Prevention of Diabetes Through Lifestyle Interventions and Population Studies in Europe and Around the World) study (5). PREVIEW was conducted among 869 overweight (BMI $25 kg/m 2 ) individuals (aged 25-70 years) with i-IFG.…”